< Billing codes

Billing code

C425A — Comprehensive physiatry consultation – hospital in-patient

Comprehensive physiatry in-patient consultation

Bill for a physiatry consultation on a hospital in-patient with at least 75 minutes of direct patient contact.

Watch for: One every 2 years by the same physician; record start and stop times, or it pays a lesser fee.

Code

C425A

Description

Comprehensive physiatry consultation – hospital in-patient

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

In-patient physiatry consultation with at least 75 minutes of direct patient contact. Same conditions as A425.

What it covers

A comprehensive physical medicine and rehabilitation consultation includes all the elements of a consultation plus at least 75 minutes in direct contact with the patient, not counting time on other separately billable services (A175).

C425 is the hospital in-patient version and is subject to the same conditions as A425 (A178).

Billing rules

• Minimum 75 minutes of direct contact with the patient; time excludes other separately billable services and non-patient-facing work such as chart or imaging review (A175).
• Limited to one every 2 years by the same physician (A175).
• Record start and stop times in the permanent record, or payment is reduced to a lesser fee (A175).
• Needs a written, signed request from the referring physician or nurse practitioner naming the patient, the referrer's billing number and the reason; otherwise it is paid as a lesser assessment (GP16).
• Same patient, same physician, same diagnosis: one consultation per two consecutive 12-month periods, with a second allowed only for an in-patient or ED consult 12–24 months after the first; a clearly unrelated diagnosis allows one per 12 months. Extra consults are paid as an assessment (GP17, GP18). Time-based consultations count toward these limits.
• Specialist consultations, limited consultations and repeat consultations get an age premium: +30% under 30 days, +25% to 1 year, +20% to 2 years, +15% to 5 years, +10% to 16 years (GP64).
• Video only (never telephone) as virtual care (Appendix J, AJ2). For in-patients or long-term care residents, the virtual physician must not be the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer must have assessed the patient in person within 30 days (A69).

Often billed with

• K001 detention, only after 120 minutes of comprehensive physical medicine and rehabilitation consultation time (GP31).

Common rejections

• ARF: The referring provider number is missing. A consultation needs a written request that names the referring physician or nurse practitioner and their billing number (GP16).
• AT2: This code may be billed by video only (Appendix J, AJ2). A virtual claim must carry K300A, not K301A (telephone).

Related codes: A425, W425, C315, C515, C316

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Physical Medicine & Rehabilitation (31), page A178.

APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing